Communicable Diseases affecting respiratory system

T or F

Chicken pox or varicella zoster virus is an acute and highly contagious disease of viral etiology characterized by vesicular eruptions on the skin and mucous membrane with mild constitutional symptoms. Humans are its only source of infection.

True

VZV is most contagious during?

A. First week of disease

B. One to two days before rash appears

C. 5 days before rash appears until all the blisters are dried and crusted

D. All throughout the course of disease

B. One to two days before rash appears (until all the blisters are dried and crusted)

Identify whether these clinical manifestations are Pre-Eruptive or Eruptive:

1. Pruritic vesicular lesions

2. Red papules

3. Rash starts from trunk

Eruptive

All stages are present simultaneously before all are covered in scabs. All lesions appear in different stages at one time or it will pass through the following stages:

Macule-->Papule-->Vesicle-->Pustule-->Crust

All are among the complications of chicken pox except:

A. Sepsis

B. Pneumonia

C. Meningoencephalitis

D. Tuberculosis

D. Tuberculosis

All are treatment modalities of VZV except:

A. Oral Acyclovir 800mg TID for 5 days

B. Oral antihistamine for symptomatic pruritus

C. Ibuprofen for pain relief

D. Calamine lotion

C. Ibuprofen for pain relief (Avoid anti-inflammatory pain killers. use acetaminophen or paracetamol for fever and pain)

Nursing management of a patient with VZV include secondary skin infection prevention, proper waste disposal, encouragement of cutting fingernails short, using mittens, and providing activities to keep the child occupied to distract client from scratching. Another one is also isolation. What type of isolation is recommended for chickenpox?

A. Contact Isolation

B. Strict isolation

C. Respiratory Isolation

D. Enteric isolation

C. Respiratory Isolation

An acute, highly contagious viral infection of the respiratory system characterized by the abrupt onset of fever, chills, muscle pain, headache, body malaise, and catarrh.

Influenza (La grippe, Flu)

Influenza first invades the respiratory mucosa (nose trachea bronchi). Rapid inflammation damages the ciliated epithelium of the tracheobronchial tree, rendering the patient vulnerable to infections of the secondary pathogens such as?

A. pneumococci

B. streptococci

C. staphylococci

D. AOTB

D. AOTB

onset is sudden and the patient reports chilly sensation, malaise, sore throat, coryza, myalgia, and headache. Severe aches and pain are usually at the?

A. Chest

B. Back

C. Throat

D. Nose

B. Back

Worst symptoms of la grippe usually last for?

3-5 Days

Viral serology include complete fixation test, hemo-agglutination test, and neutralization test. Blood examinations are usually normal but what might be noted?

A. Leukopenia

B. Hemophilia

C. Pancytopenia

D. Thrombocytopenia

A. Leukopenia

The major problem imposed by influenza are subsequent complications. Most common one is pneumonia (viral, bacterial, mixed) what category of pneumonia is less common but more severe complication of influenza?

viral primary pneumonia

There has been no specific tx for influenza and the best thing to do is stay at home, rest and drink fluids plenty, pain and fever reliever (paracetamol, ibuprofen, and aspirin unless contraindicated), limit strenuous activity, and respiratory isolation. All of these population are advised to receive their vaccines annually except:

A. 23 year old fitness coach

B. Elderly

C. person receiving chemotherapy

D. a diabetic patient

E. NOTA

A. 23 year old fitness coach

A viral respiratory disease of zoonotic origin. A serious form of pneumonia that causes ARD or severe DOB that can lead to death.

Severe Acute Respiratory Syndrome (SARS)

It has been observed that SARS is most infectious during its

A. period of decline

B. second week of illness

C. asymptomatic period

D. incubation period (2-10 days with a mean of 5 days)

B. second week of illness (symptomatic period)

T or F

SARS is primarily spread by respiratory droplets and are also shed in feces that is more prolonged than its respiratory counterpart.

Trew

WHO's guidelines to patients with suspected SARS should be isolated and accommodated in all of these except:

A. A room with door closed all the time

B. Single room with own bathroom facilities

C. Room with positive pressure

D. Room with negative pressure

C. Room with positive pressure

MERS also called Camel Flu is an illness caused by Novel corona virus (MERS-CoV). Where was the virus first reported?

Saudi Arabia, 2012

S/Sx are severe, acute, respiratory illness, similar to pneumonia. Clinical manifestations of MERS include all except:

A. Diarrhea

B. Nausea and Vomiting

C. Cough that is non-productive at first but progresses to productive with whitish sticky sputum

D. Decreased urine production (

E. NOTA

T or F

antigen testing in COVID is high in sensitivity and specificity.

False

(High in specificity but RT-PCR is higher in sensivity)

It is the ability of a test to correctly identify patients with a disease (True positives, minimizing false negatives)

Sensitivity

The ability of a test to correctly identify people without the disease. (True negatives, minimizing false positives)

Specificity

Antibiotics administered in patients with suspected infections before identification of infecting microorganism.

Empiric Antibiotic

All are Chest CT results of a patient with COVID-19 SATA

1. Traction Bronchiectasis

2. Ground glass opacification

3. Peripheral, bilateral distribution involving lower lobes

4. Consolidation lesion

5. Vascular enlargement

A. AOTB

B. 1,2,4,5

C. 2,3,5

D. 2,3,4

A. AOTB

Severe pneumonia in children may include cough, DOB, plus one of the following:

A. Central cyanosis

B. Grunting

C. Convulsions

D. A & C

E. AOTB

E. AOTB

(SpO2 of 90% on room air, Severe respiratory distress syndrome, Signs of pneumonia with general danger sign)

All of these patients are recommended to have supplemental O2 except:

A. A patient with PaO2 of 40 mmHg

B. A patient with O2 sat of 89%

C. A patient who just had a shock 30 mins ago

D. A client with Severe acute respiratory syndrome

A. A patient with PaO2 of 40 mmHg

De-escalation of empiric therapy is based on microbiology results and patient condition improvement. Empiric therapy should include treatment with what to cover for influenza?

A. oseltamivir

B. Flu vaccine

C. Chloroquine

D. Remdesivir

E. A & D

A. oseltamivir (administered orally, and is a neuraminidase inhibitor)

How sensitive is RAT in Compared to RT-PCR?

A. High

B. Moderate

C. Low

D. Very low

B. Moderate

Infectious disease that affects the lung parenchyma

Tuberculosis

Causative A.: Mycobacterium tuberculosis, bovis, intracellulare

In the disease process of pneumonia, inhalation of the bacteria then transmission of the bacteria to the alveoli causes inflammation wherein phagocytes engulf and T-lymphocytes destroys bacteria, resulting in exudates in alveoli and then bronchopneumonia. Bronchopneumonia stage is asymptomatic and manifestations occurs in?

A. 1-3 weeks prior exposure

B. 2 months after exposure

C. 2-10 weeks after exposure

D. 1-12 weeks prior exposure

C. 2-10 weeks after exposure

Granulomas are composed of live and dead bacteria and becomes a protection of bacteria. This creates the cheesy like containing bacteria called?

A. Rosmar's Tubercle

B. Khon's Tubercle

C. Sebastian's tubercle

D. Ghon's Tubercle

D. Ghon's Tubercle

The bacteria in Ghon's tubercle are latent, inactive and dormant. They become active when the Ghon's T. ulcerates. Therefore these bacteria are?

A. Conquering

B. Opportunistic

C. Colonizing

D. Inactive

B. Opportunistic

All are among the risks individuals for acquiring Tuberculosis except:

A. A work from home call center agent

B. A prisoner named Gian

C. A person who travelled to Haiti

D. Patient who received liver transplant

A. A work from home call center agent

A pathognomonic sign of TB:

A. Serosanguinous sputum

B. Non-productive cough that progresses into productive and back pain

C. Nigh sweats

D. Low-Grade afternoon fever

D. Low-Grade afternoon fever

A mantoux test is a skin test used to determine exposure to TB bacteria that includes an intradermal injection of 0.1 mL of protein derivatives causing a wheal (6-10mm) and erythema. An induration of (+) 5 mm indicates?

A. The patient is exposed to TB

B. Not clinically significant

C. Patient is exposed to TB and is immunocompromised

D. The patient was not exposed to TB

C. Patient is exposed to TB and is immunocompromised

CxR may be used to determine the extent of lesion and Ghon tubercle. What is the confirmatory diagnosis for TB that is cost efficient and available to all population?

A. Sputum Analysis

B. Mantoux test

C. GeneXpert

D. Serology testing

A. Sputum Analysis

This test is used to detect DNA of mycobacterium TB in 2 hours and a patient's resistance to rifampicin.

A. IGRAS

B. Mantoux test

C. MTB-RIF

D. RT-PCR

C. MTB-RIF or Xpert MTB/RIF Assay

All are TB agents that are the first 4 line medications except

A. Isoniazid/Pyrazinamide

B. Vit. B6 + Streptomycin

C. Ethambutol

D. Rifampicin

E. B & C

B. Vit. B6 + Streptomycin

Vitamin B6 and streptomycin may be used to prevent?

A. Multi-Resistant S. Aureus (MRSA)

B. MTRCB

C. Extensively drug resistant TB

D. MDRTB

D. MDRTB (multi drug resistant TB)

Should failure of compliance and adherence to medical regimen occurs, MDRTB may occur. These strong medications may be prescribed for MDRTB:

A. Floroquines

B. Streptomycin 2

C. Levofloxacin

D. A & B

E. a & c

E. a & c

Streptomycin is administered IM everyday. A nursing consideration is?

A. Aftercare of injection site

B. Massaging the area of injection

C. Changing the site of injection

D. Aspiration to ensure that no blood vessels were hit

C. Changing the site of injection (prevents fibrous myopathy)

Vitamin B6 and Isoniazid were medications in the TB regiment that also helps in preventing

A. Peripheral neuropathy

B. Apathy

C. Myalgia

D. Fibrous myopathy

A. Peripheral neuropathy

These drug treatments are avoided to patients with liver injuries and disease because of hepatotoxicity

A. Isoniazid

B. Ethambutol

C. Pyrazinamide

D. Rifampicin

E. A & D

E. A & D

In the new course of treatment. it was categorized into 3. In this category the intensive phase lasts 2 months with medications of Rifampicin, Iso, and Pyra. While maintenance also lasts for 2 months with meds of rifampicin and Iso. This category is for patients with negative sputum but positive on X-ray and Extrapulmonary TB is not that serious.

A. Category 1

B. Category 2

C. Category 3

C. Category 3

In this category, intensive phase is 2 months with meds of (RIPE) and maintenance of 4 months (RI). Indicated for patients with positive sputum analysis, TB with extended lung damage, and negative AFB.

A. Category 1

B. Category 2

C. Category 3

A. Category 1

This category is for patients with TB relapses and failure of therapy. 2 months of meds RIPES + 1 month of meds RIPE for intensive phase and 5 months of RIE in maintenance phase.

A. Category 1

B. Category 2

C. Category 3

B. Category 2

Nursing considerations include hydration (2,500 mL/Day), Semi-Fowler position, Coughing and Deep breathing exercises, and preventing spread of infection. All are nurses responsibility in prevention of infection spread except:

A. Mouth Care

B. Improper referral

C. Cough etiquette

D. Handwashing

B. Improper referral (proper)

An acute bacterial disease that affects both throat and skin and formation of false membrane.

Diptheria

Causative A:

Coryne bacterium diptheriae

Klebs-Leoffler bacillus

All are features of Coryne bacterium diptheriae except:

A. Gram positive (color purple)

B. Can be destroyed by light, heat, and aging

C. Aerobic bacteria

D. Non-sporylating

E. NOTA

E. NOTA

This bacteria produces toxins that is absorbed in the mucus membrane destroying the epithelium resulting in superficial inflammatory response causing low grade fever in the oropharynx. Epithelial necrosis happens thus creating a pseudo membrane. This pseudo membrane consists of: SATA

1. Necrotic tissues

2. Leukocytes

3. Thrombocytes

4. Fibrin

A. AOTB

B. 1,2,3

C. 1,2,4

D. 1,3,4

C. 1,2,4

Shick's test and moloney's test may be used in diagnosis of diptheria. All both uses ID injection. What is the difference between the two test?

A. Shick's test determines the susceptibility and immunity while moloney's detect high degree of sensitivity to D. Toxoid.

B. Both determines the susceptibility or immunity

C. Both determines the degree of sensitivity to toxoid

D. Moloney's test determines the susceptibility and immunity while Shick's detect high degree of sensitivity to D. Toxoid.

A. Shick's test determines the susceptibility and immunity while moloney's detect high degree of sensitivity to D. Toxoid.

Determine what type of diptheria: A patient has a foul smelling serosanguinous and seropurulent substance from the nose.

A. Facial Nasopharyngeal

B. Laryngeal

C. Tonsillar

D. Nasal

E. Cutaneous

D. Nasal

The patient has swollen cervical lymph nodes (bull's neck) and the relative of the patient reports halitosis.

A. Facial Nasopharyngeal

B. Laryngeal

C. Tonsillar

D. Nasal

E. Cutaneous

A. Facial Nasopharyngeal

It is the most severe type wherein the airway is obstructed because of the pseudo membrane

A. Facial Nasopharyngeal

B. Laryngeal

C. Tonsillar

D. Nasal

E. Cutaneous

B. Laryngeal

Administration of penicillin and erythromycin is to prevent spread. While administration of diptheria anti-toxin must be done after:

A. ANST

B. After AFB

C. After culture and sensitivity

D. After lab results are evaluated by the doctor

A. ANST

Nursing management of a patient with Diptheria includes full bed rest for 2 weeks, encouragement of soft diets, vitamin C rich juice, fiber and care of the nose and throat. What may be suggested or utilized by the nurse to cater the pain and swelling because of the pseudo membrane?

A. Ice chips

B. Anti-inflammatory medications

C. Ice collar

D. Removal of pseudo-membrane

C. Ice collar

Diseases characterized by uncontrollable repeated attack of spasmodic cough.

Pertussis "Whooping Cough"

Causative A.: Bordetella Pertussis

All are characteristics of the bacteria Bordetella pertussis except:

A. Gram positive bacilli

B. non-motile and easily destroyed by light, heat, and drying

C. Encapsulated

D. Gram negative bacillus

A. Gram positive bacilli

Pertussis' period of communicability is 7 days after exposure to 3 weeks after typical paroxysms. Patho: (tap)

Entry of B. Pertussis---> Confined in tracheobronchial mucosa---> Toxin release---> Attachment to epithelial cells---> Disrupts the work of cilia---> Production of tenacious mucus---> Mucus irritation by the mucosa---> Spasmodic cough

CBC may be used in aiding diagnosis which may indicate leukocytosis but is less reliable unlike sputum culture that is swabbed through?

A. Endotracheal tube specimen collection

B. Nasopharyngeal swab

C. Expectoration of sputum

D. Oropharynx swab

B. Nasopharyngeal swab

A nursing management of pertussis is to not leave children in times of paroxysms, suction anticipation (PRN), monitoring and reducing the risks of aspiration, providing warm baths, and performing CPT. Isolation and medical asepsis is also a responsibility. What type of precaution is done?

A. Respiratory precaution

B. Strict Isolation

C. Enteric precaution

D. Droplet precaution

D. Droplet precaution

In clinical manifestations of pertussis, there are 3 stages. What stage is where recurrent spasmodic cough with explosive outburst whooping cough. Cyanosis, dilated face and neck veins, tongue protrusion during paroxysms may be noted.

A. Catarrhal

B. Spasmodic

C. Convalescent

B. Spasmodic (4-6 weeks)

A patient with runny nose, frequent in sneezing, and lacrimation was admitted into the E.R. you noted that the patient also has dry bronchial cough. In what stage based on symptoms do your patient belong?

A. Catarrhal

B. Spasmodic

C. Convalescent

A. Catarrhal (1-2 weeks. most communicable)

The stage where the patient is most susceptible. There is gradual decrease in paroxysms of coughing.

A. Catarrhal

B. Spasmodic

C. Convalescent

C. Convalescent

An acute viral disease manifested by swelling of one or both parotid glands, with occasional involvement of the glandular structure, particularly the testes in males.

Mumps (Infectious/Epidemic Parotitis)

Causative A.: Paramyxovirus

What type of precaution is used in mumps?

A. Respiratory precaution

B. Strict Isolation

C. Enteric precaution

D. Droplet precaution

A. Respiratory precaution

The virus can attack other glands Epididymitis (male) and Oophoritis (female) and the virus can be found in the urine and is highly contagious. This happens because the virus can stream in the blood. This phenomenon is called?

A. Bacterelimia

B. Viremia

C. Viralinemia

D. Bacteremia

B. Viremia

This type of test is used to determine immunity to mumps

A. Hemagglutination inhibition test

B. Complete fixation test

C. Neutralization test

D. Serum amylase determination test

C. Neutralization test

This diagnostic tool is the most useful in early diagnosis of mumps

A. Hemagglutination inhibition test

B. Complete fixation test

C. Neutralization test

D. Serum amylase determination test

D. Serum amylase determination test ( increase activity of amylase = mumps)

A clinical symptom of parotitis is swelling of parotid glands, headache, and moderate fever. Ear ache may also be noted because of?

A. Because of mastitis in females

B. Because of viremia in the ears

C. Because of the toxins produced by the virus

D. Because of parotid inflammation

D. Because of parotid inflammation (aggravated by chewing)

Anti-viral meds, and supportive therapy are the medical management of people with mumps. What are the nursing considerations? SATA

1. 5 days isolation

2. Medical aseptic protective care in a single room, oral care, and terminal disinfection

3. Encouragement of foods that require mastication

4. Bed rest, hand washing and semi solid foods

A. AOTB

B. 2,3,4

C. 1,2,4

D. 1,2,4

C. 1,2,4

Complications include orchitis in males, oophoritis and mastitis in females. It can also cause deafness, pancreatitis, aseptic meningitis, arthralgia, thyroiditis and sometimes abortion. Why does it cause abortion in pregnancy?

A. Because the virus causes hormonal imbalance

B. Because the virus can cross the placental barrier

C. Because there is viremia causing infection to the baby

D. Because there inflammation of the pancreas and thyroid glands

A. Because the virus causes hormonal imbalance

An infectious disease caused by pneumococcus associated with general toxemia and inflammation then consolidation of lungs.

Pneumonia

Causative A.:

Streptococcus Pneumoniae

H. Influenzae

S. Aureus

Klebsiella pneumoniae

It is called the pnuemonia of the immunocompromised

Pneumocystis Carinii

A patient with suspected pneumonia reports of stabbing chest pain aggravated by respirations and coughing (pleuritic pain), and labored respiration. Which among these signs are pathognomonic to pneumonia?

A. Pleuritic pain with body malaise

B. Rusty/Prune Juice colored sputum

C. Egophony and whispered pectoriloquy

D. Orthopnea

B. Rusty/Prune Juice colored sputum

Drug of choice for pneumonia

Pen G

Supportive measures for pneumonia are humidified o2 therapy for hypoxia, adequate fluid intake, bed rest, and bronchodilators and expectorants. What kind of diet is recommended for patients with pneumonia?

A. High CHON & CHO diet

B. High fat and calorie diet

C. high in vitamin c diet

D. high calorie diet

D. high calorie diet

A nurses responsibility is to ensure patent airway and oxygenation, teach coughing and deep breathing exercises, obtain sputum specimen while also noting for its color, viscosity, odor, and proper disposal of soiled materials and monitoring vital signs. To surpass secretion and suction it, what do you anticipate?

A. Intubation

B. Suction using french gauge 18

C. Endotracheal tube insertion

D. Venturi mask with alternate suctioning

A. Intubation

A viral disease that produces exanthema and enanthema that usually affects children and URT.

Measles

Causative A.: Filtrable virus that belongs to genus morbilivirus of the family paramyxoviridae

Measles can be transmitted through droplet and airborne precautions. There are two types of measles. What type has 14-21 days of incubation. A period of communicability of 7 days before, to about 5 days after the rash appears. It can be passed through direct, indirect, and airborne contact including sputum, feces, urine, and sometimes blood. It can cross the placenta. It's pathognomonic sign is Lymphadenopathy (post auricular, sub occipital, post cervical lymphadenopathy)

A. Measles Rubeola

B. German Rubella Measles

B. German Rubella Measles

This type of measles has 10-20 days of incubation. A period of communicability from 4 days before and about 5 days after rash appears. Its mode of transmission are airborne, and direct that can also be transmitted through the urine, blood, and stool. Rashes begins behind the ears and spread to feet, fever, malaise, coryza, and cough may be present. Its pathognomonic sign is Koplik's Spot (small, red with bluish white center and red base) found in mucosa opposite to molar teeth.

A. Measles Rubeola

B. German Rubella Measles

A. Measles Rubeola

Medical/nursing management of measles include oxygenation, vaporizer use, bed rest, supportive tx, isolation, antipyretics, and separation of pregnant women to children. Why do we use dim lights in patient's with measles?

A. Because of light sensitivity related to malaise

B. Because of the koplik's spot may be present in the eyes

C. Because of conjunctivitis

D. Because there photosensitivity

D. Because there photosensitivity

(letter b and c may also cause photosensitivity)